Significant Gaps Remain Between Autism Research, Policy, and Practice

Despite substantial growth in autism research over the past two decades, significant gaps persist between evidence-based recommendations and their application in pediatric clinical practice, according to a commentary published in Autism Research.

Researchers from the A.J. Drexel Autism Institute at Drexel University highlighted that although robust evidence supports the effectiveness of standardized autism screening tools and Naturalistic Developmental Behavioral Interventions (NDBIs), their use remains inconsistent among healthcare providers and early intervention practitioners.

In the commentary, the researchers identified barriers preventing the translation of autism research into policy and practice, focusing specifically on early autism screening and interventions. Utilizing the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, the authors examined how “big P” policies (legislation and agency regulations) and “little p” policies (guidelines set by professional organizations) influence clinical and community adoption of recommended practices.

It was found that, despite clear policy directives, many pediatricians in the United States do not adhere to recommended screening practices. The American Academy of Pediatrics guidelines, which recommend standardized autism-specific screening tools like the Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) at 18 and 24 months, were significantly underutilized. In other recent studies, it has been concluded that only about half of US children receive autism screening at both recommended 18 and 24-month visits using standardized tools.

Furthermore, among pediatricians who do use these screening tools, there was a considerable inconsistency in referring children for further evaluation. For example, some researchers found even when screening indicates a heightened likelihood of autism, pediatricians often failed to consistently follow through with referrals for diagnostic evaluation.

Similarly, the adoption of Naturalistic Developmental Behavioral Interventions (NDBIs), which integrate developmental science with behavioral and educational strategies in naturalistic settings, remained limited despite substantial empirical support. Although NDBIs were endorsed as best practice for early autism intervention, surveys indicated that a large majority of early intervention practitioners lack familiarity with these methods. Researchers also noted that most clinicians and early childhood educators neither incorporate NDBIs nor receive adequate training in these approaches.

Several systemic barriers contributed to these gaps. Practitioner training remained inadequate, leading to limited understanding and application of recommended screening and intervention methods. Inefficiencies within referral systems exacerbated these issues, further delaying critical diagnoses. Limited access to specialized diagnostic care creates additional hurdles, particularly in underserved regions. Socioeconomic disparities compounded these challenges, with children from lower-income families facing an average delay of up to 10 months in receiving an autism diagnosis compared to their more affluent peers. This delay severely restricted their timely access to early intervention services, underscoring a significant public health concern.

The authors concluded, “Suboptimal outcomes for those on the autism spectrum are a well-documented problem that illustrate why…research, policy, practice, interdisciplinary science, stakeholder engagement, [and] implementation science…needs to work together to lead to change.”

This article originally appeared on Psychiatry Advisor